All-Terrain Vehicle Injury Prevention

Healthcare Providers' Knowledge, Attitudes, and the Anticipatory Guidance They Provide

Charles A. Jennissen; Gerene M. Denning; Shane Sweat; Karisa Harland; Christopher Buresh


J Community Health. 2012;37(5):968-975. 

In This Article

Abstract and Introduction


All-terrain vehicles (ATVs) continue to be an increasing cause of injuries and deaths in children, especially in rural communities. More children die in the United States each year from ATV-related events than from bicycle crashes. The purpose of this study was to determine the ATV anticipatory guidance practices of primary care providers, as well as their attitudes, knowledge, and the barriers faced in educating families about the risk of ATV use. An electronic survey was administered to primary care providers belonging to state medical societies. More than 60% of respondents (Total N = 218) believed that ATV anticipatory guidance was important to provide to pediatric patients and their families. However, 78% stated they provide ATV safety counseling less than 10% of the time during regular pediatric exams, and only 12% stated they do so greater than 25% of the time. Families rarely ask providers for advice on ATV safety issues; 84% of providers were asked once a year or less. ATV knowledge scores were low (median score 2 of 12); however, those with previous ATV exposure had significantly higher scores. Many respondents affirmed insufficient knowledge (47%) and inadequate resources (63%), but the most commonly identified barrier was that it was not a routine part of their practice. Providers in the study demonstrated limited knowledge, reported multiple barriers, and provided little or no ATV safety counseling. However, they consider ATV anticipatory guidance important for their patients. Armed with increased knowledge and appropriate resources, providers could play a significant role in promoting ATV safety.


All-terrain vehicle (ATV) use is a significant and increasing cause of injuries and deaths. In the US alone, there were 833 ATV-related deaths in 2006, more than three times the number of deaths in 1998.[1] Children under 16 years of age have comprised just over one-quarter of all ATV-related fatalities, with 43% of child victims under the age of 12.[1] In fact, more children die from ATV crashes than from riding bicycles.[2]

Based on National Electronic Injury Surveillance System data, there are about 150,000 ATV-related emergency department visits each year. Roughly 1 in 3 of these visits are by children under 16, and well over half of patients are under 24 years of age.[1,3,4]

The injuries and deaths caused by ATVs is primarily a problem of rural communities, large suburban acreages, and off-road vehicle recreational areas. Farm families are particularly vulnerable due to a high rate of ATV exposure. In 2000, a survey of 645 students participating in agricultural education programs in Arkansas revealed that 74% of farm youth had ridden an ATV in the previous month compared to 41% of their rural non-farm peers.[5]

Although most ATVs are designed for adults, children are often allowed to drive them, frequently with unsafe behaviors (e.g., no helmet, riding with passengers).[6] A national case–control study found that the adjusted risk of injury on an ATV is 12 times higher for children than for older adult drivers.[7]

Anticipatory guidance is a mainstay of medical visits, especially well-child and routine adolescent exams. The focus of such counseling has shifted from infectious diseases towards injury prevention as injury has become the primary threat to children's health. As the cost of injuries has dramatically risen over the past several decades, prevention has become an increasingly cost effective use of a clinician's time.

There is growing evidence that counseling-based interventions for children's health and development are associated with improved functional outcomes.[8] Among these, injury prevention counseling is supported by the best evidence,[9,10] including interventions to increase use of motor vehicle restraints[11] and wearing bicycle helmets.[12,13] Medical organizations, including the American Academy of Pediatrics and the American Academy of Family Physicians, recognize the integral role of anticipatory guidance in preventing injuries in children and teens and promote safety counseling in their preventative healthcare guidelines.

To our knowledge, no studies have reported on family physician and mid-level provider anticipatory guidance for ATV injury prevention. To address this issue among our state's primary healthcare providers, we measured their attitudes toward ATV injury prevention counseling in the office, the amount of ATV safety anticipatory guidance they presently provide, their knowledge of ATV safety and laws, and the barriers they identified to providing more guidance to children and their families.